Estimating the Causal Effect of Low Tidal Volume Ventilation on Survival in Patients with Acute Lung Injury
*Chenguang Wang, FDA 

Keywords: Causal inference, Dynamic treatment regime, G-computation formula

Acute lung injury (ALI) patients typically require mechanical ventilation. Low tidal volume ventilation (LTVV), a time-varying dynamic treatment regime, has been recommended as an effective ventilation strategy. This recommendation was based on the results of the ARMA study. After publication of the ARMA trial, some critics focused on the high non-adherence rates in the LTVV arm suggesting that non-adherence occurred because treating physicians felt that deviating from the prescribed regime would improve patient outcomes. We seek to address this controversy by estimating the survival distribution in the counterfactual setting where all patients assigned to LTVV followed the regime. Inference is based on a fully Bayesian implementation of Robins' (1986) G-computation formula.